Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-08T08:10:44.311Z Has data issue: false hasContentIssue false
  • English
  • Français

Responding to Crisis: Patterns of Health Care Utilization in Central Kenya Amid Economic Decline

Published online by Cambridge University Press:  23 May 2014

Paul N. Mbatia  and
York W. Bradshaw
Get access Rights & Permissions [Opens in a new window]

Abstract:

African states have become increasingly unable to provide adequate health care to their citizens due to debt, structural adjustment, poverty, and mismanagement. The health crisis is worsening in many areas and driving up mortality rates after decades of decline. This article investigates how African communities and their citizens respond in light of state inability to deliver health-related services. Drawing on a survey of more than five hundred rural Kenyans, our analysis shows that people are dissatisfied with government facilities and are turning to mission clinics and hospitals as well as to private clinics. A number of factors determine choice of health-care facility, including cost, level of education, socioeconomic background, the time taken to reach a facility, the type of disease requiring treatment, and agro-ecological zones. These findings have profound theoretical implications for health and development models, which normally are biased in favor of developed Western countries.

Résumé:

Résumé:

À cause de la dette, de l'ajustement structurel, de la pauvreté et d'une mauvaise gestion, les états africains sont devenus de plus en plus incapables d'offrir une couverture médicale adéquate à leurs citoyens. La crise de la santé s'aggrave dans de nombreuses régions et fait grimper les taux de mortalité après des années de régression. Cet article examine comment les communautés africaines et leurs citoyens réagissent au vu de l'incapacité de l'état à leur offrir des services liés à la santé. En s'inspirant d'une enquête effectuée sur plus de cinq cent Kenyans ruraux, notre analyse montre que la population n'est pas satisfaite des structures offertes par le gouvernement et qu'elle se tourne vers les cliniques et hôpitaux de mission ainsi que vers les cliniques privées. Un nombre de facteurs détermine le choix de ces structures médicales, comme par exemple le coût, le niveau d'instruction, le milieu socio-économique, le temps nécessaire pour atteindre une structure, le type de maladie à traiter, et les zones agro-écologiques. Ces résultats ont de profondes implications théoriques sur les modèles de santé et de développement qui d'habitude sont influencés en faveur des pays occidentaux développés.

Type
Articles
Information
African Studies Review , Volume 46 , Issue 1 , April 2003 , pp. 69 - 92
Copyright
Copyright © African Studies Association 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Akin, John S., et al. 1985. The Demand for Primary Health Services in the Third World. New York: Rowman and Allanheld.Google Scholar
Amonoo-Lartson, R., et al. 1984. District Health Care: Challenges for Planning, Organization and Evaluation in Developing Countries. London: Macmillan.CrossRefGoogle Scholar
Asthana, Sheena. 1994. “Economic Crisis, Adjustment and Impact.” In Health and Development, edited by Phillips, David and Yola, Verhasselt, 50–63. London: Routledge.Google Scholar
Barkan, Joel. 1992. “The Rise and Fall of the Governance Realm in Kenya.” In Governance and Politics in Africa, edited by Hyden, Goran and Bratton, Michael, 167–219. Boulder, Colo.: Lynne Rienner.CrossRefGoogle Scholar
Bradshaw, York W. 1993. “State Limitations, Self-Help Secondary Schooling, and Development in Kenya.” Social Forces 72: 347–78.CrossRefGoogle Scholar
Bradshaw, York, Kaiser, Paul, and Ndegwa, Stephen. 1995. “Rethinking Theoretical and Methodological Approaches to the Study of African Development. African Studies Review 38: 39–65.CrossRefGoogle Scholar
Daily Nation. 1993. “Time to Focus on the Dying Child.” 06 16, p. 6.Google Scholar
Fuller, Bruce. 1991. Growing-Up Modern: The Western State Builds Third-World Schools. New York: Routledge.Google Scholar
Good, Charles. 1988. The Community in African Primary Health Care: Strengthening Participation and a Proposed Strategy. Studies in African Health and Medicine, vol. 2. Lewiston/Queenston: Edwin Mellen Press.Google Scholar
Kaiser, Paul. 1996. Culture, Transnationalism and Civil Society in Africa: A Study of the Aga Khan and His Followers in Tanzania. Boulder, Colo.: Greenwood Press.Google Scholar
Kalipeni, Ezekiel. 2000. “Health and Society in Southern Africa in Times of Economic Turbulence.” In The Uncertain Promise of Southern Africa, edited by Bradshaw, York and Ndegwa, Stephen, 327–62. Bloomington: Indiana University Press.Google Scholar
Karin, E. Johnson, et al. 1989. “Community-Based Health Care in Kibweze, Kenya: Ten Years in Retrospect.” Social Science and Medicine 28: 1039–51.Google Scholar
Kasaje, Dan. 1992. “The Process of Empowerment.” Conference Proceedings. Nairobi: African Medical and Research Foundation.Google Scholar
Kessler, Susi. 1983. “The Interrelationship of Health and Development in Africa.” In Health and Development in Africa. New York: Verlag.Google Scholar
Manundu, M., Mondi, F., and Rao, G. O.. 1989. “Health Care Delivery.” In Report of the Proceedings of the Workshop on the Impact of Structural Adjustment Policies on the Wellbeing of the Vulnerable Groups in Kenya, edited by Adada, J. E. O. and Ayako, A. B.. Nairobi: English Press Limited.Google Scholar
Mburu, F. M. 1981. “Implications of the Ideology and Implementation of Health Policy in a Developing Country.” Social Science and Medicine 15A: 17–24.Google Scholar
Mburu, F. M.. 1989. “Whither Community-Based Health Care?” Social Science and Medicine 28: 1073–79.CrossRefGoogle ScholarPubMed
Mcpake, Barbara, Hanson, Kara, and Mills, Anne. 1993. “Community Financing of Health Care in Africa.” Social Science and Medicine 36: 1383–95.CrossRefGoogle ScholarPubMed
Mwabu, Germano, 1990. Financing Health Services in Africa: An Assessment of Alternative Approaches. Washington, D.C.: World Bank.Google Scholar
Mwabu, Germano, Ainsworth, Martha, and Nyamete, Andrew. 1995. “The Effects of Prices, Services, and Service Quality and Availability on the Demand for Medical Care: Insights from Kenya.” In Financing Health Care in Sub-Saharan African through User Fees and Insurance, edited by Shaw, Paul R. and Ainsworth, Martha, 85–102. World Bank Discussion Papers: Africa Technical Department Series No. 294. Washington, D.C.: World Bank.Google Scholar
Ndegwa, Stephen. 1996. The Two Faces of Civil Society: NGOs and Politics in Africa. West Hartford, Conn.: Kumarian Press.Google Scholar
Republic of Kenya. 1989–1996. National Development Plans. Nairobi: Government Printer.Google Scholar
World Bank. 1999. World Development Report 1999. New York: Oxford University Press.Google Scholar
World Bank. 2000. World Development Report 2000. New York: Oxford University Press.Google Scholar
Van Ginneken, J. K, et al. 1984. Maternal and Child Health in Rural Kenya: An Epidemiological Study. London: Croom Helm.Google Scholar